MEDICARE: MISS ELIZABETH CLAIRE CARLISLE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	6021	SC

General Provider Information

NPI Number	:	1538489182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH CLAIRE CARLISLE DPT

Provider Business Mailing Address
First Line	:	36 COLLETON DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7301
Country	:	US
Telephone Number	:	843-847-6908
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 QUEENSBOROUGH BLVD
Second Line	:	SUITE 104
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5431
Country	:	US
Telephone Number	:	843-216-0290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2010
Last Update Date	:	06/06/2010

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